For years, prominent medical centers have been dancing with the devil. Recently, one got burned.
On January 6, 2017, Dr. Daniel Neides posted his thoughts on cleveland.com. Neides claimed that within 12 hours of receiving a preservative-free influenza vaccine, “I was in bed feeling miserable and missed two days of work with a terrible cough and body aches. What I did not realize is that the preservative-free vaccine contains formaldehyde. How can you call it preservative-free when it still contains a preservative?”
Actually, formaldehyde isn’t a preservative. It’s an inactivating agent used to kill influenza virus. Now the vaccine virus can’t reproduce itself and cause symptoms (like those suffered by Neides) but it can induce a protective immune response. Although Dr. Neides was right to notice that trace quantities of formaldehyde remain in the vaccine, he neglected to mention that formaldehyde is also produced by the body naturally—a necessary component in the formation of vital nucleic acids and proteins. Indeed, the quantity of formaldehyde in human blood is about 100 times greater than that contained in vaccines.
Neides later stated that vaccines, while beneficial, might be responsible for “neurological diseases like autism and ADHD, [which are] increasing at alarming rates.”1 More than 20 studies have shown that vaccines don’t cause autism or other developmental disabilities.
What was unique about Daniel Neides wasn’t what he said (anti-vaccine activists have sounded similar themes for decades), or that a doctor had said it (a handful of private practitioners have also taken up the cause of the anti-vaccine movement). What was unique was the attribution at the end of the article: “Dr. Daniel Neides is the Medical Director and Chief Operating Officer of the Cleveland Clinic Wellness Institute.”1 The Cleveland Clinic is nationally recognized as one of the top medical centers in the world. Indeed, U.S. News & World Report rates the Cleveland Clinic as the nation’s #1 hospital for Cardiology and Cardiovascular Surgery; the Clinic is also among the nation’s top hospitals in many other categories.
Neides’s comments touched off a firestorm on social media. Why would a top-ranked hospital support a doctor who damned vaccines? The hospital was quick to respond: “The Cleveland Clinic is fully committed to evidence-based medicine. Harmful myths and untruths about vaccinations have been scientifically debunked in rigorous ways…Our physician published his statement without authorization from the Cleveland Clinic. His views do not reflect the position of the Cleveland Clinic and appropriate disciplinary action will be taken.”
What happened to the Cleveland Clinic could have happened to any one of a number of prominent medical centers. Hospitals affiliated with Harvard, Yale, Penn, and many others have for years employed clinicians in centers variously labeled integrative, holistic, wellness, complementary, and alternative. Because alternative medicine is popular, and because healthcare is a marketplace, even the best medical centers have tried to cash in on what has become a multi-billion-dollar-a-year industry. But it’s a tricky business.
Alternative therapies include acupuncture, homeopathy, naturopathy, reiki, and therapeutic touch, among others. The good news is that some of these therapies offer certain benefits; the bad news is that their origins are built on sand.
Take acupuncture, for example. Acupuncture is the product of 2nd century B.C. China, a culture that didn’t believe in dissection. As a consequence, the ancient Chinese didn’t know anything about human anatomy. Chinese acupuncturists believed that healing occurred by balancing yin and yang, allowing the body’s vital energy, Qi, to flow. To achieve this balance, thin needles were inserted 0.5 to 4 inches under the skin along 12 longitudinal arcs called meridians. The Chinese picked 12 meridians because there are 12 great rivers in China. The Chinese also believed that the body was divided into about 360 different parts because there are about 360 days in the year. Because the human nervous system isn’t based on rivers in China or days in the year, one can assume that the placement of needles was entirely arbitrary.
Nonetheless, acupuncture can work to relieve pain. Researchers have found that acupuncture causes some people to release endorphins: pain-relieving opiate-like neuropeptides made by the pituitary gland. (Endorphin is a contraction of endogenous, meaning produced in the body, and morphine.) In other words, acupuncture has a physiological basis. And acupuncture is far safer than taking opioids or cox-2 inhibitors (like Vioxx) or non-steroidal anti-inflammatories.
To their credit, several alternative healers have looked further into why acupuncture works. They’ve asked, “Does it matter where you put the needles.” The answer was no; needles could be inserted along prescribed meridians or randomly; both worked. They’ve asked, “Do needles need to puncture the skin?” This question was answered by a brilliant physician named Edzard Ernst, a professor of complementary medicine at the University of Exeter in England. Ernst developed a retractable needle; patients could now feel the needle but didn’t know whether it had been inserted under the skin. Ernst found that acupuncture still worked. In other words, acupressure works just as well as acupuncture.
Edzard Ernst and other alternative healers did what they should have done. They argued that if a therapy like acupuncture works, it is incumbent upon clinicians to figure out why it works. In so doing, they can determine the least painful, least burdensome, least expensive, and safest way to induce an endorphin response. In a better world, acupressure would now replace acupuncture. Although acupuncture is safe, it isn’t absolutely safe. Acupuncture needles have occasionally broken off and lodged in livers, lungs, and hearts. Also, inadequately sterilized acupuncture needles have been contaminated with human immunodeficiency virus (HIV) or hepatitis B virus.
The problem with acupuncture is that many practitioners actually believe in yin and yang and Qi. Instead of trying to understand the physiological or biological basis for why their therapy might work, they promote themselves as something separate from modern science—something more ethereal, magical, other-worldly, Eastern. And in that rejection of science, these same physicians might then turn around and do exactly what Dr. Daniel Niedes did—reject other aspects of modern science, like the science of vaccines.
In the end, there is no such thing as alternative medicine; if an alternative medicine works, then it’s medicine; and if it doesn’t work, then it’s not an alternative. In any case, it’s all subject to scientific study. We no longer have to shrug our shoulders and look to the gods for an explanation.
Paul A. Offit, MD is a professor of pediatrics and the director of the Vaccine Education Center at The Children’s Hospital of Philadelphia. He is the author of Pandora’s Lab: Seven Stories of Science Gone Wrong (National Geographic Press, April 2017).